Diabetes mellitus is one of troublesome disorder for the orthopaedic patient who should be operated on some other problems. Internist will advice and take care of them as far as diabetic problem is concern. However, orthopaedic surgeon should fully understand and follow every details about the condition of his own patient.
Gamerin-Davalos hadclassified the diabetes mellitus into four. types. of potentiate, chemical and clinical diabetes. Potentiate form is not detectable at present method. The chemical and latent chemical forms are subclinical types and wi1J be detected by the special. examinations. In the orthopaedic practice, surgeon should keep in mind ands perform proper tests for any suspecious .symptomes or histories related-to diabetes mellitus. Administration of insulin for the diabetes; should be full doses but nerve be .over-dosed.
Neuropathy, vascular changes and infections are the :common complications to diabetic patient .and closely influence to the prognosis of major surgery. Ellenbery et al. had emphasized that the neuropathy is not a complication but rather a concomitantfeature of diabetes mellitus. It may appear nerve root ´ symptome to confuse with the herniated intervertebral .disc. Vascualrchange of the thickening of capillary basement membrane will causes gangrene of extremities and unexpected massive bleeding during surgery. Susceptibility of infection on´ diabetic patient is well knov~w fact and in .case of chronic ~ osteomyelitis or tuberculosis of bone persist for long time without specific reason, surgeon should check once for the posibility of diabetes mellitus. Administration of any general anesthetic agents will elevate blood sugar level especially the ether, however, fluothane is a selective one at present.
In case of surgery on diabetic patient, aceton uric and -COs combining power should be checked closely for #our to five days post-operatively. Blood sugar level should be kept slightlyelevated during and post-operative period for diabetic patient. Surgeon should check his patient for any complications in case of increased dose of insulin is required post-operatively.
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